January is Cervical Health Awareness Month and a time that you see and hear more information on the topic from your healthcare provider and the media.
The reason for a month dedicated to raising awareness about cervical health is that most women don’t give much thought to their cervix unless it is time for an annual exam or while giving birth (at which time the cervix makes its presence well-known). The reason women aren’t likely to pay much attention to that part of their anatomy at other times is that it’s internal and generally goes unnoticed even if something is amiss – the critical reason a medical professional should examine it from time to time.
Since its Cervical Health Awareness Month, it seems appropriate to provide some awareness about the cervix itself. Let’s be honest, ladies. Do we know what our cervix actually does?
“Cervix” is Latin for “neck” and is the lower-most portion of the uterus. It carries out many critical functions that contribute to the overall reproductive health and wellbeing of women as it
- allows the passage of menstrual fluid;
- promotes fertility;
- closes during pregnancy to keep the fetus inside and protects the uterus, upper reproductive tract, and a developing fetus from pathogens
- widens (dilates) during labor to allow the baby to be born
To keep the cervix healthy, we must also understand its health threats.
News reports and advertisements for certain vaccines in recent years make it likely that you are already aware of Human Papillomavirus (HPV) and its relation to cervical cancer, but what some people don’t realize is that other sexually transmitted infections (STIs) also pose a huge risk to cervical health. Gonorrhea, Chlamydia, and HIV are all problems for the cervix since the cervix acts as the primary site of infection. Undetected Gonorrhea or Chlamydia can lead to long-term reproductive health problems, including infertility.
According to the American Cancer Society (2016 a), the following can increase your risk for cervical cancer:
- Human papillomavirus (HPV) infection
- Weakened immune system
- Chlamydia infection
- A diet low in fruits and vegetables
- Being overweight
- Family history of cervical cancer
In addition to the more recent availability of vaccines, there is another, not so new way to keep your cervix healthy. The Papanicolaou test (more commonly referred to as a Pap smear, Pap test, cervical smear, or smear test) is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes. The cervix is swabbed during a Pap smear and cervical cells are viewed under a microscope.
Since the Pap smear became part of a routine pelvic exam, deaths from cervical cancer have dropped dramatically. Although the test is not 100% accurate (it has its share of false positive and false negative results), we cannot overstate the importance of this test as a screening tool.
The 2016 recommendations from the American Cancer Society suggest the following guidelines to help find cervical cancer early or prevent pre-cancers from progressing into cervical cancer (2016 b).
- All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every three years. HPV testing is not necessary for screening in this age group (although it may be part of a follow-up for an abnormal Pap test).
- Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every five years and should continue until age 65.
- Another reasonable option for women 30 to 65 is to get tested every three years with just the Pap test.
- Women who are at high risk of cervical cancer for various reasons may need to screenings more often and should follow the recommendations of their healthcare team.
- Women over 65 years of age who have had regular screening in the previous ten years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers. Women with a history of CIN2 or CIN3 should continue to test for at least 20 years (CIN stands for cervical intraepithelial).
- Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests) unless the hysterectomy was a treatment for cervical pre-cancer (or cancer). Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening according to the guidelines above.
- Women of any age should NOT be screened every year by any screening method.
- Women who have an HPV vaccine should still follow these guidelines
Some women believe that they can stop cervical cancer screenings once they stop having children. Not true. Women should continue to follow American Cancer Society guidelines and understand that those guidelines may change in the future. Following the recommendations of your medical provider is also important.
While Cervical Health Awareness Month is only one month of the year, please make sure you understand the importance of cervical health and encourage other women in your life to learn more during the other 11 months of the year as well.
Now is the perfect time of year to add another resolution to your list. Resolve to have a healthy cervix and talk to your healthcare provider to schedule an appointment to be screened.
Terrence E. Babb, MD, FACOG, FACS reviewed the information presented here.
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American Cancer Society (2016a). What are the risk factors for cervical cancer? Retrieved from https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-risk-factors.html
American Cancer Society (2016b). The American Cancer Society guidelines for the prevention and early detection of cervical cancer. Retrieved from https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html